Healthcare Provider Details

I. General information

NPI: 1639159007
Provider Name (Legal Business Name): FRANK ALLAN BRETTSCHNEIDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 PINE GROVE AVE SUITE A
PORT HURON MI
48060-3382
US

IV. Provider business mailing address

1522 PINE GROVE AVE SUITE A
PORT HURON MI
48060-3382
US

V. Phone/Fax

Practice location:
  • Phone: 810-982-3277
  • Fax: 810-982-0716
Mailing address:
  • Phone: 810-982-3277
  • Fax: 810-982-0716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberFB009336
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberFB009336
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberFB009336
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: